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VA Decision Accuracy Question


RBrogen

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I got a decision letter from a recent claim I submitted and it does explain for the most part how they reached their decision. If I am reading it correctly, I believe that they left out several important things when applying the rating:  For example, I have a 2 claims, one for each knee. I'll post thee Right Knee as both are the exact same issue as I've had meniscus tears and scope surgery on both, 2x on Left and 1x on Right).  They only gave me Arthritis for each knee at 10%.  Shouldn't that be at least 20% because there are meniscus tears, popping out etc. or should it be 10% for arthritis and 20% for meniscus on both?

Here's what my decision letter has:

image.png.01c30a3e9f028e2a9c8f73e16194e631.png

Here is what my C&P wrote:

image.png.f5e0470cc9f8a2273b2a65975a667b88.png

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You can not be rated for both "arthritis" and "meniscus" for your knees, that would be considered pyramiding. Were the tears corrected through surgery? I do agree that the rating should be higher if your knee is locking up on a frequent basis as stated on the C&P. If you have new evidence that show these issues then I would do a reconsideration and explain what the examiner has missed.

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1 minute ago, paulstrgn said:

You can not be rated for both "arthritis" and "meniscus" for your knees, that would be considered pyramiding. Were the tears corrected through surgery? I do agree that the rating should be higher if your knee is locking up on a frequent basis as stated on the C&P. If you have new evidence that show these issues then I would do a reconsideration and explain what the examiner has missed.

The surgeries didn't correct the issues, only cleaned up the debris and hanging edges of the tears.  The main issues of locking, pain etc still exist.  I wasn't sure if arthritis and meniscus would be pyramiding or considered 2 different conditions.  Thanks for the info Paul.

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Read the critieria for your condition:  https://www.law.cornell.edu/cfr/text/38/4.71a

See how the symptoms listed in the critiera compare with what the doctor said about your's.  If the doc did not document all your symptoms, then you may need an IMO/IME.    Then you can decide if rated properly, or you are likely to win on appeal.  

That is my advice.  

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14 minutes ago, broncovet said:

Read the critieria for your condition:  https://www.law.cornell.edu/cfr/text/38/4.71a

See how the symptoms listed in the critiera compare with what the doctor said about your's.  If the doc did not document all your symptoms, then you may need an IMO/IME.    Then you can decide if rated properly, or you are likely to win on appeal.  

That is my advice.  

Thanks Broncovet.  I have all sorts of IMO/IMEs documented.  The other thing is also they noted pain in ROM but didn't indicate at what point in the ROM that the pain started so that the ROM limitation was accurate.  I have already requested a higher-level review to see if they will adjust the knees and my IVDS/DDD because they didn't consider my straightening lordosis diagnosis documented in the C&P, only arthritis.

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"Higher level Review" (HLR) should be used "only" when you are sure you have no new evidence.  Otherwise, you want to use Supplemental Claim Lane (SCL).  If you are not sure what evidence VA has in its possession, I recommend SCL.  HLR is a one way street, where you can not submit new evidence.  I dont recommend going down that road unless your claim has "enough gas" to get all the way back again.   That means you have a full tank, full of Caluza elements, and symptoms.  And you know its full because you just filled up.  The gas gauge does not work well because we dont know how much, of our evidence VA actually has.  "Regular people", that is, non VSO's, or non attorney's, dont have access to VBMS, which is where our cfile is stored online.  If you hire Alex, he can see your VBMS file.  VSO's can also, but they dont have a clue what to do with that info.   

This is my opinion.   I say, use HLR only with extreme caution.  If in doubt, use SCL.   

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